髓内钉技术与微创钛板技术治疗胫骨骨折的Meta分析
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摘要
目的利用Meta分析对髓内钉技术(Intramedullary nailing,IMN)与微创钛板内固定技术(Minimally Invasive titanium plate internal fixation,MIPPO)在治疗胫骨远端骨折中的疗效进行对比分析。方法计算机检索Pubmed、Cochrane Library、Embasee、medline、science direct、万方、维普、中国知网、CMB中国生物医学库等数据库,检索时限为2000年1月至2018年12月。根据纳入和排除标准筛选出符合本文要求的文献。以手术时间、术中出血量、骨折愈合时间、术后承重时间、踝关节最大背伸度数、AOFAS评分、Johner-Wruhs评价标准和术后并发症为主要分析指标,用Review Manager 5.3软件进行Meta分析。结果本文共计纳入文献9篇,共632例胫骨远端骨折患者,IMN组322例,MIPPO组310例。结果表明两组手术方式在手术时间、术中出血量、骨折愈合时间、术后承重时间、踝关节AOFAS评分、Johner-Wruhs评分和术后并发症方面均无统计学差异,仅在踝关节最大背伸度数有统计学差异(SMD:-1.08,95%CI:-1.45～-0.71,P<0.00001)。在踝关节最大背伸度数方面,MIPPO组要明显优于IMN组。结论无论用髓内钉技术还是微创钛板内固定技术均是治疗胫骨远端骨折常用的治疗方法,均能取得令人满意的疗效。
Objective To compare the efficacy of intramedullary nailing(IMN)and minimally invasive titanium plate internal fixation(MIPPO)in the treatment of distal tibial fractures by Meta-analysis.Methods Pubmed,Cochrane Library,Embasee,medline,science direct,Wanfang,Weipu,China HowNet,CMB China Biomedical Database and other databases were retrieved by computer.The retrieval time was from January 2000 to December 2018.According to the inclusion and exclusion criteria,the literature that meets the requirements of this paper was screened out.The operation time,intraoperative bleeding volume,fracture healing time,post-operative load-bearing time,maximum ankle extension,AOFAS score,Johner-Wruhs score and post-operative complications were used as the main analysis indicators.Meta-analysis was performed with Review Manager 5.3 software.Results A total of 9 articles were included,632 cases of distal tibial fracture,322 cases in IMN group and 310 cases in MIPPO group.The results showed that there were no significant differences in operation time,intraoperative bleeding volume,fracture healing time,post-operative load-bearing time,AOFAS score,Johner-Wruhs score and postoperative complications between the two groups,except for the maximum ankle extension(SMD:-1.08 95% CI:-1.45～-0.71,P<0.00001).In terms of maximum ankle extension,MIPPO group was significantly better than IMN group.Conclusion Both intramedullary nailing and minimally invasive titanium plate internal fixation are commonly used in the treatment of distal tibial fractures,which can achieve satisfactory results.
Objective To compare the efficacy of intramedullary nailing(IMN)and minimally invasive titanium plate internal fixation(MIPPO)in the treatment of distal tibial fractures by Meta-analysis.Methods Pubmed,Cochrane Library,Embasee,medline,science direct,Wanfang,Weipu,China HowNet,CMB China Biomedical Database and other databases were retrieved by computer.The retrieval time was from January 2000 to December 2018.According to the inclusion and exclusion criteria,the literature that meets the requirements of this paper was screened out.The operation time,intraoperative bleeding volume,fracture healing time,post-operative load-bearing time,maximum ankle extension,AOFAS score,Johner-Wruhs score and post-operative complications were used as the main analysis indicators.Meta-analysis was performed with Review Manager 5.3 software.Results A total of 9 articles were included,632 cases of distal tibial fracture,322 cases in IMN group and 310 cases in MIPPO group.The results showed that there were no significant differences in operation time,intraoperative bleeding volume,fracture healing time,post-operative load-bearing time,AOFAS score,Johner-Wruhs score and postoperative complications between the two groups,except for the maximum ankle extension(SMD:-1.08 95% CI:-1.45～-0.71,P<0.00001).In terms of maximum ankle extension,MIPPO group was significantly better than IMN group.Conclusion Both intramedullary nailing and minimally invasive titanium plate internal fixation are commonly used in the treatment of distal tibial fractures,which can achieve satisfactory results.
引文
[1] KHAN A D,CASSERLY H B.Early results with the PERI-LOC plate for distal femoral and proximal tibial fracture[J].J Orthopaed,2010,7(2):112-117.
[2] BONG M R,KUMMER,F J,KOVAL K J,et al.Intramedullary nailing of the lower extremity biomechanics and biology[J].J Am Acad Orthop Surg,2007,15(2):97-106.
[3] KUHN S,APPELMANN P,PAIRON P,et al.The Retrograde Tibial Nail presentation and biomechanical evaluation of a new concept in the treatment of distal tibia fractures[J].Injury,2014,45S1:81-86.
[4] HUPEL T M,WEINBERG J A,AKSENNOV S A,et al.Effect of unreamed,limited reamed,and standard reamed intramedullary nailing on cortical bone porosity and new bone formation[J].J O～hop Trauma,2001,15(1):18-27.
[5] FAN C.Interlocking nails for displaced metaphyseal fractures of the distal tibia[J].Injury-international Journal of the Care of the Injured,2005,36(5):669-674.
[6] POWELL J,DEGROOTE R,SEIDEL J,et al.Reamed VCISUS unreamed intramedullary nailing of the femur:Comparison of the rate of ARDS in multiple injured patients[J].J Orthop Trauma,2006,20(6):384-387.
[7] XIONG R,MAI Q G,YANG C L,et al.Intramedullary nailing for femoral shaft fractures in adults(protocol)[J].Cochrane Database of Systematic Reviews,2012,1(1):CD008241.
[8] SEYHAN M,UNAY K,SENER N.Intramedullary nailing versus percu-taneous locked plating of distal extra-articular tibial fractures:a retro-spective study[J].Eur J Orthop Surg Traumatol,2013,23(5):595-601.
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[10] VALLIER H A,CURETON B A,PATTERSON B M.Factors influencing functional outcomes after distal tibia shaft fractures[J].J Orthop Trauma,2012,26(3):178-183.
[11] GUO J J,TANG N,YANG H L,et al.A prospective,randomised trial comparing closed intramedullary nailing with percutaneous plating n the treatment of distal metaphyseal fractures of the tibia[J].J Bone Joint Surg Br,2010,92(7):984-988.
[12] IM G I,TAE S K.Distal metaphyseal fractures of tibia:a prospective randomized trial of closed reduction and intramedullary nail versus open reduction and plate and screws fixation.[J].Journal of Trauma,2005,59(5):1219.
[13] JANSSEN K W,BIERT J,VAN KAMPEN A.Treatment of distal tibial fractures:plate versus nail:a retrospective outcome analysis of matched pairs of patients[J].Int Orthop,2007,31(5):709-714.
[14] KWOK C S,CROSSMAN P T,LOIZOU C L.Plate versus nail for distal tibial fractures:a systematic review and meta-analysis[J].J Orthop Trau-ma,2014,28(9):542-548.
[15] FAN C Y,CHIANG C C,CHUANG T Y,et al.Interlocking nails for displaced metaphyseal fractures of the distal tibia[J].Injury,2005,36(5):669-674.
[16] MOHAMMED A,SARAVANAN R,ZAMMIT J,et al.Intram edullary tibial nailing in distal third tibial fractures:distal loc king screws and fracture nonunion[J].Intorthop,2008,32(4):547-549.
[17] 姚琦,倪杰,彭立彬,等.微创经皮钢板固定术与交锁髓内钉治疗胫骨远端关节外骨折疗效的观察[J].中华医学杂志,2013,93:3748-3751.
[18] TAVAKOLI A,TADI H M,MAHMOODIAN A.A comparison between unreamed locked intramedullary nailing and plate-screw fixation in thetreatment of tibial diaphyseal fractures[J].Iranian Red Crescent Med J,2010,12(6):640.
[19] LI Y,LIU L,TANG X,et al.Comparison of low,multidirectional locked nailing and plating in the treatment of distal tibial metadiaphy-seal fractures[J].Int Orthop,2012,36(7):1457-1462.
[20] 梁博伟,赵劲民,殷国前,等.经皮微创钢板固定治疗胫骨下段骨折:与髓内钉固定和切开复位钢板内固定的比较.中国组织工程研究,2012,16(17):3116-3120.
[21] BEYTEMUR O,BARZS A,ALBAY C,et al.Comparison of intramedullary nailing and minimal invasive plate osteosynthesis in the treatment of simple intra-articular fractures of the distal tibia(AO-OTA type 43 C1-C2)[J].Acta Orthop Traumatol Turc,2017,51(1):12-16.
[22] KAWALKAR A C,BADOLE C M.Distal tibia metaphyseal fractures:Which is better,intra-medullary nailing or minimally invasive plate osteosynthesis?[J].Journal of Orthopaedics,Trauma and Rehabilitation,2018,24:66-71.
[23] 张志新,周君东,陈兴阳,等.锁定加压接骨板结合微创经皮钢板内固定技术与交锁髓内钉治疗老年性胫骨中下段骨折[J].中国组织工程学,2017,21(15):2378-2382.
[24] 唐军伟,麦合木提,蔡佳,等.胫骨多向锁定髓内针与胫骨远端钢板治疗胫骨远端骨折的疗效比较[J].中国矫形外科杂志,2016,24(24):2247-2251.
[25] 刘旭良,王兵,刘贻运,等.微创固定系统与髓内钉固定治疗胫骨干骨折的疗效比较[J].中国医学前沿杂志,2014,6(7):86-89.
[26] BILGILI F,AYHAN KILI?,SAMI S?KüCü,et al.Retrospective analysis of AO 42A-B type tibia fractures treated with percutaneus locked plating and intramedullary nailing[J].Ulusal travma ve acil cerrahi dergisi=Turkish journal of trauma & emergency surgery:TJTES,2016,22(1):90-96.
[27] 曾健聪,林卓锋,杨云海,等.微创内固定技术与切开复位钢板内固定治疗胫骨远端骨折的效果比较[J].中国当代医药,2014,21(16):63-67.
[28] COOMER A R,LEWIS D D,WIEDNER E,et a1.Stabilization of juxta-physeal distal tibial and fibular fractures in a juvenile tiger using a hybrid circular-linear external fixator [J].Veterinary Surg,2012,41(2):248-253.
[29] BEARDI J,HESSMANN M,HANSEN M,et al.Operative treatment of tibial shaft fractures:a comparison of different methods of primary stabilisation.[J].Arch Orthop Trauma Surg.2008,128(7):709-715.
[30] NEWMAN S D S,MAUFFREY C P C,KRIKLER S.Distal metadiaphyseal tibial fractures[J].Injury-international Journal of the Care of the Injured,2011,42(10):975-984.
[2] BONG M R,KUMMER,F J,KOVAL K J,et al.Intramedullary nailing of the lower extremity biomechanics and biology[J].J Am Acad Orthop Surg,2007,15(2):97-106.
[3] KUHN S,APPELMANN P,PAIRON P,et al.The Retrograde Tibial Nail presentation and biomechanical evaluation of a new concept in the treatment of distal tibia fractures[J].Injury,2014,45S1:81-86.
[4] HUPEL T M,WEINBERG J A,AKSENNOV S A,et al.Effect of unreamed,limited reamed,and standard reamed intramedullary nailing on cortical bone porosity and new bone formation[J].J O～hop Trauma,2001,15(1):18-27.
[5] FAN C.Interlocking nails for displaced metaphyseal fractures of the distal tibia[J].Injury-international Journal of the Care of the Injured,2005,36(5):669-674.
[6] POWELL J,DEGROOTE R,SEIDEL J,et al.Reamed VCISUS unreamed intramedullary nailing of the femur:Comparison of the rate of ARDS in multiple injured patients[J].J Orthop Trauma,2006,20(6):384-387.
[7] XIONG R,MAI Q G,YANG C L,et al.Intramedullary nailing for femoral shaft fractures in adults(protocol)[J].Cochrane Database of Systematic Reviews,2012,1(1):CD008241.
[8] SEYHAN M,UNAY K,SENER N.Intramedullary nailing versus percu-taneous locked plating of distal extra-articular tibial fractures:a retro-spective study[J].Eur J Orthop Surg Traumatol,2013,23(5):595-601.
[9] VALLIER H A,CURETON B A,PATTERSON B M.Randomized prospective comparison of plate versus intramedullary nail fixation for distal tibia shaft fractures[J].J Orthop Trauma,2011,25(12):736-741.
[10] VALLIER H A,CURETON B A,PATTERSON B M.Factors influencing functional outcomes after distal tibia shaft fractures[J].J Orthop Trauma,2012,26(3):178-183.
[11] GUO J J,TANG N,YANG H L,et al.A prospective,randomised trial comparing closed intramedullary nailing with percutaneous plating n the treatment of distal metaphyseal fractures of the tibia[J].J Bone Joint Surg Br,2010,92(7):984-988.
[12] IM G I,TAE S K.Distal metaphyseal fractures of tibia:a prospective randomized trial of closed reduction and intramedullary nail versus open reduction and plate and screws fixation.[J].Journal of Trauma,2005,59(5):1219.
[13] JANSSEN K W,BIERT J,VAN KAMPEN A.Treatment of distal tibial fractures:plate versus nail:a retrospective outcome analysis of matched pairs of patients[J].Int Orthop,2007,31(5):709-714.
[14] KWOK C S,CROSSMAN P T,LOIZOU C L.Plate versus nail for distal tibial fractures:a systematic review and meta-analysis[J].J Orthop Trau-ma,2014,28(9):542-548.
[15] FAN C Y,CHIANG C C,CHUANG T Y,et al.Interlocking nails for displaced metaphyseal fractures of the distal tibia[J].Injury,2005,36(5):669-674.
[16] MOHAMMED A,SARAVANAN R,ZAMMIT J,et al.Intram edullary tibial nailing in distal third tibial fractures:distal loc king screws and fracture nonunion[J].Intorthop,2008,32(4):547-549.
[17] 姚琦,倪杰,彭立彬,等.微创经皮钢板固定术与交锁髓内钉治疗胫骨远端关节外骨折疗效的观察[J].中华医学杂志,2013,93:3748-3751.
[18] TAVAKOLI A,TADI H M,MAHMOODIAN A.A comparison between unreamed locked intramedullary nailing and plate-screw fixation in thetreatment of tibial diaphyseal fractures[J].Iranian Red Crescent Med J,2010,12(6):640.
[19] LI Y,LIU L,TANG X,et al.Comparison of low,multidirectional locked nailing and plating in the treatment of distal tibial metadiaphy-seal fractures[J].Int Orthop,2012,36(7):1457-1462.
[20] 梁博伟,赵劲民,殷国前,等.经皮微创钢板固定治疗胫骨下段骨折:与髓内钉固定和切开复位钢板内固定的比较.中国组织工程研究,2012,16(17):3116-3120.
[21] BEYTEMUR O,BARZS A,ALBAY C,et al.Comparison of intramedullary nailing and minimal invasive plate osteosynthesis in the treatment of simple intra-articular fractures of the distal tibia(AO-OTA type 43 C1-C2)[J].Acta Orthop Traumatol Turc,2017,51(1):12-16.
[22] KAWALKAR A C,BADOLE C M.Distal tibia metaphyseal fractures:Which is better,intra-medullary nailing or minimally invasive plate osteosynthesis?[J].Journal of Orthopaedics,Trauma and Rehabilitation,2018,24:66-71.
[23] 张志新,周君东,陈兴阳,等.锁定加压接骨板结合微创经皮钢板内固定技术与交锁髓内钉治疗老年性胫骨中下段骨折[J].中国组织工程学,2017,21(15):2378-2382.
[24] 唐军伟,麦合木提,蔡佳,等.胫骨多向锁定髓内针与胫骨远端钢板治疗胫骨远端骨折的疗效比较[J].中国矫形外科杂志,2016,24(24):2247-2251.
[25] 刘旭良,王兵,刘贻运,等.微创固定系统与髓内钉固定治疗胫骨干骨折的疗效比较[J].中国医学前沿杂志,2014,6(7):86-89.
[26] BILGILI F,AYHAN KILI?,SAMI S?KüCü,et al.Retrospective analysis of AO 42A-B type tibia fractures treated with percutaneus locked plating and intramedullary nailing[J].Ulusal travma ve acil cerrahi dergisi=Turkish journal of trauma & emergency surgery:TJTES,2016,22(1):90-96.
[27] 曾健聪,林卓锋,杨云海,等.微创内固定技术与切开复位钢板内固定治疗胫骨远端骨折的效果比较[J].中国当代医药,2014,21(16):63-67.
[28] COOMER A R,LEWIS D D,WIEDNER E,et a1.Stabilization of juxta-physeal distal tibial and fibular fractures in a juvenile tiger using a hybrid circular-linear external fixator [J].Veterinary Surg,2012,41(2):248-253.
[29] BEARDI J,HESSMANN M,HANSEN M,et al.Operative treatment of tibial shaft fractures:a comparison of different methods of primary stabilisation.[J].Arch Orthop Trauma Surg.2008,128(7):709-715.
[30] NEWMAN S D S,MAUFFREY C P C,KRIKLER S.Distal metadiaphyseal tibial fractures[J].Injury-international Journal of the Care of the Injured,2011,42(10):975-984.